Effects of Preoperative Quadruple Therapy for Helicobacter pylori on Bariatric Surgery Metabolic Outcomes.

PURPOSE: To assess the effects of Helicobacter pylori (HP) eradication with an omeprazole, clarithromycin, amoxicillin, and metronidazole (OCAM) regimen on the metabolic profile and weight loss 12 months after bariatric surgery (BS). METHODS: Retrospective analysis of a prospective cohort of patients with morbid obesity undergoing BS. HP presence was tested preoperatively by gastric biopsy and treated with OCAM when positive. Short-term metabolic outcomes and weight loss were evaluated. RESULTS: HP infection was detected in 75 (45.7%) of the 164 patients included. OCAM effectiveness was 90.1%. HP-negative patients had a greater reduction in glucose levels at 3 (-14.6 ± 27.5 mg/dL HP-treated vs -22.0 ± 37.1 mg/dL HP-negative, p=0.045) and 6 months (-13.7 ± 29.4 mg/dL HP-treated vs -26.4 ± 42.6 mg/dL HP-negative, p= 0.021) and greater total weight loss (%TWL) at 6 (28.7 ± 6.7% HP-treated vs 30.45 ± 6.48% HP-negative, p= 0.04) and 12 months (32.21 ± 8.11% HP-treated vs 35.14 ± 8.63% HP-negative, p= 0.023). CONCLUSIONS: Preoperative treatment with OCAM has been associated to poorer glycemic and weight loss outcomes after BS. More research is needed on the influence of OCAM on gut microbiota, and in turn, the effect of the latter on metabolic and weight loss outcomes after BS.

Unveiling hidden toxin diversity: Discovery of novel venom components through manual curation of highly expressed sequences annotated as "no hits" in Phoneutria nigriventer spider venom gland transcriptome.

Spider venoms have evolved over thousands of years, optimizing feeding and defense mechanisms. Venom components show pharmacological and biotechnological potential, rising interest in their study. However, the isolation of spider toxins for experimental evaluation poses significant challenges. To address this, transcriptomic analysis combined with computational tools has emerged as an appealing approach to characterizing spider venoms. However, many sequences remain unidentified after automatic annotation. In this study, we manually curated a subset of previously unannotated sequences from the Phoneutria nigriventer transcriptome and identified new putative venom components. Our manual analysis revealed 29 % of the analyzed sequences were potential venom components, 29 % hypothetical/uncharacterized proteins, and 17 % cellular function proteins. Only 25 % of the originally unannotated dataset remained without any identification. Most reclassified components were cysteine-rich peptides, including 23 novel putative toxins. We also found glycine-rich peptides (GRP), corroborating the previous description of GRPs in Phoneutria pertyi venom glands. Furthermore, to emphasize the recurrence of the lack of annotation in spider venom glands transcripts, we provide a survey of the percentage of unidentified sequences in several published spider venom transcriptomics studies. In conclusion, our study highlights the importance of manual curation in uncovering novel venom components and underscores the need for improved annotation strategies to fully exploit the medical and biotechnological potential of spider venoms.

Efeito imediato da mobilização com movimento (MWM) em pacientes com dor lombar: um estudo randomizado controlado / Immediate effect of mobilization with movement (MWM) in patients with low back pain: a randomized controlled trial

Objective: To analyze the effect of the Mobilization With Movement (MWM) of the Mulligan's concept in the perception of nociceptive and neuropathic pain, range of motion (ROM) and joint mobility of individuals with low back pain. Method: This is a randomized and controlled clinical trial, with 30 volunteers with nonspecific low back pain, divided into: Intervention Group (INTG), that received sustained natural apophyseal glides (SNAG) type MWM of the Mulligan's concept; Control Group (CONTG), which received a similar intervention to INTG. Volunteers were assessed using the Numeric Rating Scale for Pain (NRS Pain); the Modified Schober Test (MST) and ROM by goniometry for lumbar spine mobility and Douleur Neuropatique 4 (DN4) questionnaire for assessment of neuropathic and nociceptive pain. Results: INTG showed an increase in lumbar flexion (pre-intervention= 81.21±15.23°; post-intervention= 90.00±19.62°, p< 0.05), mobility of the lumbar spine in MST (pre= 15.33±1.05 post= 16.08±1.02, p< 0.05) and reduction of pain perception by NRS Pain (pre= 5.33±2.26; post= 1.47±2.61 p< 0.05) and in CONTG (pre= 4.07±2.34; post= 2.20±1.93, p< 0.05). Conclusion: The intervention with MWM - SNAGs promoted improved ROM and mobility in flexion of the lumbar spine, associated with reduction from the nociceptive pain in INTG and CONTG.

Objetivo: Analisar o efeito da Mobilization Whith Movement (MWM) do conceito Mulligan na percepção de dor nociceptiva e neuropática, na amplitude e na mobilidade articular de indivíduos com dor lombar. Métodos: Trata-se de um ensaio clínico randomizado e controlado, de 30 voluntários com dor lombar inespecífica, divididos em: Grupo Intervenção (GINT) que recebeu a mobilização articular com deslizamentos apofisários naturais mantidos (MWM - SNAGs); Grupo Controle (GCONT), que recebeu uma mobilização articular placebo. Os voluntários foram avaliados pela escala numérica de dor (EVN); pelo teste modificado de Schober (TMS) para a mobilidade da coluna lombar e pelo DN4 para avaliação da dor neuropática e nociceptiva. Resultados: GINT apresentou aumento da flexão lombar (pré intervenção= 81,21±15,23°; pós-intervenção= 90,00±19,62°, p= <0,05), da mobilidade da coluna lombar no TMS (pré= 15,33±1,05 pós= 16,08±1,02, p= <0,05) e redução da percepção de dor pela EVN (pré= 5,33±2,26; pós= 1,47±2,61= p< 0,05) e no GCONT (pré= 4,07±2,34; pós= 2,20±1,93, p < 0,05). Conclusão: A intervenção com MWM - SNAGs promoveu melhora da ADM e da mobilidade na flexão da coluna lombar, associada com redução da dor nociceptiva no GINT e no GCONT.

The COVID-19 Crisis and the Incidence of Alcohol-Related Deaths in Poland.

BACKGROUND Identifying risk and protective factors for excessive alcohol consumption can inform targeted health policies, reducing the impact of potential mental health crises. This study examined the validity and reliability of COVID-19-related death data and explored the correlations among age, sex, residential status, alcohol abuse, and healthcare access. MATERIAL AND METHODS This analysis of Polish residents' mortality relies on individual data from the register of deaths maintained by Statistics Poland. This study examined deviations in the number of deaths between 2020 and 2021 by analyzing specific causes of death. RESULTS Alcohol abusers had increased COVID-19 risk factors compared to the general population. F10 values were 22% higher than expected in 2020, aligning with predictions for 2021. Higher mortality rates were observed in the first year of the pandemic. In 2020, women and rural residents were more affected (31% and 25% higher than expected, respectively), while men and urban residents were less affected (21% and 20% higher than expected, respectively). In 2021, the trend reversed, with men 2% higher than predicted and women 4% lower. Urban area residents had a 77% lower than expected value, while rural area residents were similar (8% higher). Overall mortality exceeded expectations in both 2020 (13% higher) and 2021 (23% higher). In 2021, alcohol-related non-mental health problems increased by more than 40% in standardized death rates (SDRs). CONCLUSIONS Alcohol-related deaths reflect the hidden effects of the pandemic. Measuring the pandemic's impact on global excess mortality is hindered by inconsistencies in COVID-19 death reporting.

Exploring the Link Between Attention-Deficit Hyperactivity Disorder and Cannabis Use Disorders: A Review.

Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder in children and adults. In the substance use disorders (SUDs) population, ADHD prevalence reaches 23.1%, leading to more severe substance abuse progression and reduced treatment effectiveness. Cannabis is the most common illicit drug used among the ADHD population. The increasing popularity of medical marijuana (MM) has raised concerns about its potential impact on neurocognitive functions, particularly in adolescents. Persistent cannabis use can cause permanent changes in brain structures and circuits. This review aims to overview the comorbidity of ADHD and SUDs, focusing on cannabis use disorders. Theoretical models of the etiologies of ADHD and SUDs were investigated to establish a framework for analyzing their underlying neurocognitive mechanisms. The reward and motivational brain circuitries involving the default-mode network and the endocannabinoid system were emphasized. The high prevalence of SUDs in the ADHD population has ramifications, including earlier age of onset, self-medication, and reduced performance in various domains. Cannabis use disorders are particularly significant due to the increasingly widespread use of cannabis and its perceived safety. The review highlights the lack of theoretical background on the therapeutic properties of medicinal cannabis, criticizing its speculated applications in the ADHD population. This article reviews the current understanding of the association between ADHD and cannabis use, emphasizing the need for further research and a cautious approach to MM's potential therapeutic applications.

Percepção dos profissionais sobre a alimentação/nutrição em cuidados paliativos / Professional perception of palliative care nutrition / Percepción de los profesionales sobre la alimentación/nutrición en los cuidados paliativos

Resumo Cuidados paliativos promovem qualidade de vida e alívio de sofrimento a pacientes e seus familiares. Nesse contexto, a estratégia a ser adotada na alimentação desses pacientes envolve reflexões da equipe de saúde. Esta pesquisa tem como objetivo verificar a compreensão de profissionais da área hospitalar que atuam no setor de oncologia sobre a nutrição/alimentação de pacientes sob cuidados paliativos. Realizaram-se individualmente entrevistas com dez profissionais, que compreenderam que os cuidados melhoram a qualidade de vida por meio do controle de sintomas físicos, psicológicos e espirituais dos pacientes e seus familiares. Entendem que, além do atendimento das necessidades nutricionais, a alimentação pode proporcionar prazer, conforto e memória afetiva, e que a comunicação é fundamental para um cuidado integrado e humanizado. Assim, julga-se importante desenvolver estratégias de intervenção a partir de treinamentos e da educação continuada desses profissionais.

Abstract As palliative care intends to promote quality of life and relief of suffering for patients and family, the feeding strategies adopted in this context require reflection from the patient care team. Hence, this study examined how oncology hospital professionals perceive the nutrition/feeding of palliative care patients. We conducted individual interviews with ten professionals, who saw palliative care as improving the quality of life of patients and family by managing physical, psychological and spiritual symptoms. For them, in addition to meeting nutritional needs, food can bring pleasure, comfort and evoke affective memories, with communication being a key element to an integrated and humanized care. Thus, developing intervention strategies for the training and continuing education of these professionals is paramount.

Resumen Los cuidados paliativos proporcionan calidad de vida y alivio del sufrimiento de los pacientes y sus familiares. En este contexto, la estrategia que se utiliza en la alimentación de estos pacientes implica reflexiones del equipo de salud. Esta investigación tiene como objetivo identificar la comprensión de los profesionales que trabajan en el sector de la oncología sobre la nutrición/alimentación de los pacientes bajo cuidados paliativos. Se realizaron entrevistas individuales a diez profesionales, para quienes la atención mejora la calidad de vida mediante el control de los síntomas físicos, psicológicos y espirituales de los pacientes y sus familiares. Además de satisfacer las necesidades nutricionales, la alimentación puede proporcionar placer, confort y memoria afectiva, y la comunicación es fundamental para una atención integrada y humanizada. Por lo tanto, se considera importante desarrollar estrategias de intervención basadas en la formación y la educación continua de estos profesionales.

Removal or substitution of in feed antimicrobials in swine production.

Antimicrobial substitutes are being used in pig production systems, to maintain the health of the animals without compromising their performance. The aim of this study is to evaluate the impact of either the removal of in feed antimicrobials or their substitution for feed additives, at the nursery and growing/finishing stages. At weaning, 1091 piglets were sexed, vaccinated, homogenized by weight and allocated to six treatments during the nursery stage (26-63 d): T1- feed with no antimicrobials nor additives; T2 - feed with antimicrobials; T3 - feed with prebiotic; T4 - feed with probiotic; T5 - feed with essential oils; T6 - feed with organic acids. The same treatments were applied to 840 pigs during the growing/finishing stages (64-167 d). There was no effect of the treatments on feed conversion at the nursery (P = 0.222) and the growing/finishing (P = 0.809) stages. The average daily gain did not differ across treatments in the nursery (P = 0.342) and in growing/finishing (P = 0.050). The cost of the interventions with injectable drugs was not different between the treatments neither at the nursery (P = 0.990) nor at the growing/finishing (P = 0.310). However, the pneumonia and pleurisy index for all treatments was equal or above 1.0, which indicates a respiratory challenge. There was an increase in the cost with antimicrobials or additives per kg of feed produced, which impacts the cost per kg of pig produced. In conclusion, the removal of antimicrobials in pig diets is financially feasible and their substitution by additives did not impact growing performance.

Basiliximab Does Not Impair Airway Mucociliary Clearance of Rats.

Previous studies have shown that immunosuppressive drugs impair the airway mucociliary clearance of rats. However, considering the high specificity of basiliximab (BSX) and the absence of studies reporting its side effects, our aim was to investigate whether BSX, associated or not with triple therapy, impairs the mucociliary system. Forty rats were divided into 4 groups: Control, BSX, Triple, and BSX + Triple. After 15 days of treatment, animals were euthanized and the ciliary beating frequency (CBF), mucociliary transport velocity (MCTV), neutral and acid mucin production, Muc5ac and Muc5b gene expression, inflammatory cell number, and interleukin (IL)-6 concentration were analyzed. CBF and MCTV were lower in Triple and BSX + Triple groups (p < 0.05). Neutral mucin percentage was higher in Triple group (p < 0.05), and acid mucin percentage was higher in Triple and BSX + Triple groups (p < 0.05). The Muc5ac and Muc5b gene expression was higher in Triple and BSX + Triple groups (p < 0.05). Animals from Triple and BSX + Triple groups presented fewer mononuclear cells (p < 0.05). The number of polymorphonuclear cells was higher in the Triple group (p < 0.05). In the analysis of inflammatory cells in the blood, there was a decrease in lymphocytes and an increase in neutrophils in the Triple and BSX + Triple groups (p < 0.05). The concentration of IL-6 significantly increased in the animals of the Triple and BSX + Triple groups (p < 0.05). BSX did not change the mucociliary apparatus of rats.

Bariatric surgery and non-alcoholic fatty liver disease / Cirugía bariátrica e hígado graso no alcohólico

Non-alcoholic fatty liver disease (NAFLD) is a chronic disease that may lead to cirrhosis and hepatocellular carcinoma; its close relationship with obesity and the metabolic syndrome involves an increasing prevalence. Invasive liver biopsy is the gold standard diagnosis technique for NAFLD but entails risks. Therefore, transient elastography, a non-invasive technique with high reliability, is frequently used in clinical practice. Bariatric surgery is the only effective treatment for long-term weight loss and obesity-related metabolic conditions improvement. Although studies report encouraging results of bariatric surgery as a valuable therapy for NAFLD, guidelines for its use in NAFLD are ambiguous. Indeed, the mechanisms driving this improvement are largely unknown, but likely involve weight loss-dependent and independent factors including anatomic and hormonal changes. This review aims to update the relationship between NAFLD and bariatric surgery, focusing on the indications for surgery and the mechanisms implied in NAFLD improvement. (AU)

El hígado graso no alcohólico (HGNA) es una enfermedad crónica que puede conducir a cirrosis y hepatocarcinoma; su relación con la obesidad y el síndrome metabólico supone un aumento en su prevalencia. La biopsia hepática es la prueba diagnóstica de elección, pero implica riesgos. En consecuencia, la elastografía hepática, una técnica no invasiva con una alta fiabilidad, es utilizada frecuentemente en la práctica clínica. La cirugía bariátrica es el único tratamiento eficaz para la pérdida de peso y la mejoría de las comorbilidades a largo plazo. Aunque los estudios demuestran que la cirugía bariátrica es efectiva para el tratamiento del HGNA, la mayoría de los mecanismos implicados en esta mejoría se desconocen. De hecho, las guías clínicas son ambiguas en cuanto a su indicación. Esta revisión tiene como objetivo actualizar la relación entre el HGNA y la cirugía bariátrica, centrándose en las indicaciones de la cirugía y los mecanismos implicados en la mejoría del HGNA. (AU)

Bariatric surgery and non-alcoholic fatty liver disease.

Non-alcoholic fatty liver disease (NAFLD) is a chronic disease that may lead to cirrhosis and hepatocellular carcinoma; its close relationship with obesity and the metabolic syndrome involves an increasing prevalence. Invasive liver biopsy is the gold standard diagnosis technique for NAFLD but entails risks. Therefore, transient elastography, a non-invasive technique with high reliability, is frequently used in clinical practice. Bariatric surgery is the only effective treatment for long-term weight loss and obesity-related metabolic conditions improvement. Although studies report encouraging results of bariatric surgery as a valuable therapy for NAFLD, guidelines for its use in NAFLD are ambiguous. Indeed, the mechanisms driving this improvement are largely unknown, but likely involve weight loss-dependent and independent factors including anatomic and hormonal changes. This review aims to update the relationship between NAFLD and bariatric surgery, focusing on the indications for surgery and the mechanisms implied in NAFLD improvement.

Prolonged rectal shedding of SARS-CoV-2 in a 22-day-old-neonate: a case report.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes the novel coronavirus disease 2019 (COVID-19), which is characterized by a diverse clinical picture. Children are often asymptomatic or experience mild symptoms and have a milder disease course compared to adults. Rectal shedding of SARS-CoV-2 has been observed in both adults and children, suggesting the fecal-oral route as a potential route of transmission. However, only a few studies have investigated this in neonates. We present a neonate with a mild disease course and prolonged rectal SARS-CoV-2 shedding. CASE PRESENTATION: A 22-day old neonate was admitted to the hospital with tachycardia and a family history of COVID-19. The boy later tested positive for COVID-19. His heart rate normalized overnight without intervention , but a grade 1/6 heart murmur on the left side of the sternum was found. After excluding signs of heart failure, the boy was discharged in a habitual state after three days of admission. During his admission, he was enrolled in a clinical study examining the rectal shedding of SARS-CoV-2. He was positive for SARS-CoV-2 in his pharyngeal swabs for 11 days after initial diagnosis and remained positive in his rectal swabs for 45 days. Thereby, the boy remained positive in his rectal swabs for 29 days after his first negative pharyngeal swab. CONCLUSIONS: The presented case shows that neonates with a mild disease course can shed SARS-CoV-2 in the intestines for 45 days. In the current case, it was not possible to determine if fecal-oral transfer to the family occurred, and more research is needed to establish the potential risk of the fecal-oral transmission route.

Bariatric surgery improves metabolic and nonalcoholic fatty liver disease markers in metabolically healthy patients with morbid obesity at 5 years.

BACKGROUND: No studies have evaluated the effect of metabolic and bariatric surgery (MBS) on nonalcoholic fatty liver disease (NAFLD) and cardiometabolic markers in metabolically healthy patients with morbid obesity (MHMO) at midterm. OBJECTIVES: To assess the effect of MBS on NAFLD and cardiometabolic markers in MHMO patients and ascertain whether metabolically unhealthy patients with morbid obesity (MUMO) remain metabolically healthy at 5 years after MBS. SETTING: University hospital. METHODS: A total of 191 patients with a body mass index >40 kg/m2 and at least 5 years of follow-up were retrospectively analyzed. Lost to follow-up were 37.6% (151 of 401 patients). Patients were classified as MHMO if 1 or 0 of the cardiometabolic markers were present using the Wildman criteria. The degree of liver fibrosis was assessed using the NAFLD fibrosis score (NFS). RESULTS: Forty-one patients (21.5%) fulfilled the criteria for MHMO. They showed significant improvements in blood pressure (from 135.1 ± 22.1 and 84.2 ± 14.3 mm Hg to 117.7 ± 19.2 and 73.0 ± 10.9 mm Hg), plasma glucose (from 91.0 ± 5.6 mg/dL to 87.2 ± 5.2 mg/dL), homeostatic model assessment for insulin resistance (from 2.2 ± .9 to 1.0 ± .8), triglycerides (from 88.0 [range, 79.5-103.5] mg/dL to 61.0 [range, 2.0-76.5] mg/dL), alanine aminotransferase, gamma-glutamyl transpeptidase NFS (from -1.0 ± 1.0 to -1.9 ± 1.2), and high-density lipoprotein cholesterol (from 56.9 ± 10.5 mg/dL to 77.9 ± 17.4 mg/dL) at 5 years after surgery. A total of 108 MUMO patients (84.4%) who became metabolically healthy after 1 year stayed healthy at 5 years. CONCLUSIONS: MBS induced a midterm improvement in cardiometabolic and NAFLD markers in MHMO patients. Seventy-six percent of MUMO patients became metabolically healthy at 5 years after MBS.

In(compatibility) of intravenous drugs in critical units: adult cohort.

OBJECTIVES: To analyze potential (in)compatibilities of intravenous drugs based on the scheduling prepared by the nursing team. METHODS: historic cohort (retrospective) with 110 adults in critical units. Intravenous medications were identified concomitantly, whose pairs were analyzed for (in) compatibility using the screening system Trissel's™ 2 Compatibility IV-Micromedex 2.0. Parametric and non-parametric statistic were used according to the nature of the variable. RESULTS: 565 pairs of drugs were identified. Of these, 44.9% were compatible; and 8.8%, potentially incompatible. Most potentially incompatible pairs involved substances with alkaline pH such as phenytoin (32%) and sodium bicarbonate (8%) and weak acids such as midazolam (12%) and dobutamine (6%), which could result in precipitate formation. CONCLUSIONS: almost half of the mixtures simultaneously administrated was compatible, which indirectly reflects in the organized work between the nursing team and the clinical pharmaceutic in the discussions and decisions related to time scheduling.

The Prevalence and Clinical Implications of Rectal SARS-CoV-2 Shedding in Danish COVID-19 Patients and the General Population.

Background: SARS-CoV-2 has resulted in a global pandemic since its outbreak in Wuhan, 2019. Virus transmission primarily occurs through close contact, respiratory droplets, and aerosol particles. However, since SARS-CoV-2 has been detected in fecal and rectal samples from infected individuals, the fecal-oral route has been suggested as another potential route of transmission. This study aimed to investigate the prevalence and clinical implications of rectal SARS-CoV-2 shedding in Danish COVID-19 patients. Methods: Hospitalized and non-hospitalized adults and children who were recently tested with a pharyngeal COVID-19 test, were included in the study. A rectal swab was collected from all participants. Hospitalized adults and COVID-19 positive children were followed with both pharyngeal and rectal swabs until two consecutive negative results were obtained. RT-qPCR targeting the envelope gene was used to detect SARS-CoV-2 in the samples. Demographic, medical, and biochemical information was obtained through questionnaires and medical records. Results: Twenty-eight of 52 (53.8%) COVID-19 positive adults and children were positive for SARS-CoV-2 in rectal swabs. Seven of the rectal positive participants were followed for more than 6 days. Two of these (28.6%) continued to test positive in their rectal swabs for up to 29 days after the pharyngeal swabs had turned negative. Hospitalized rectal positive and rectal negative adults were comparable regarding demographic, medical, and biochemical information. Furthermore, no difference was observed in the severity of the disease among the two groups. Conclusions: We provided evidence of rectal SARS-CoV-2 shedding in Danish COVID-19 patients. The clinical importance of rectal SARS-CoV-2 shedding appears to be minimal.

In(compatibility) of intravenous drugs in critical units: adult cohort / In(compatibilidad) de medicamentos intravenosos en unidades críticas: cohorte de adultos / In(compatibilidade) de medicamentos intravenosos em unidades críticas: coorte de adultos

ABSTRACT Objectives: To analyze potential (in)compatibilities of intravenous drugs based on the scheduling prepared by the nursing team. Methods: historic cohort (retrospective) with 110 adults in critical units. Intravenous medications were identified concomitantly, whose pairs were analyzed for (in) compatibility using the screening system Trissel's™ 2 Compatibility IV-Micromedex 2.0. Parametric and non-parametric statistic were used according to the nature of the variable. Results: 565 pairs of drugs were identified. Of these, 44.9% were compatible; and 8.8%, potentially incompatible. Most potentially incompatible pairs involved substances with alkaline pH such as phenytoin (32%) and sodium bicarbonate (8%) and weak acids such as midazolam (12%) and dobutamine (6%), which could result in precipitate formation. Conclusions: almost half of the mixtures simultaneously administrated was compatible, which indirectly reflects in the organized work between the nursing team and the clinical pharmaceutic in the discussions and decisions related to time scheduling.

RESUMEN Objetivos: analizar las (in)compatibilidades potenciales de medicamentos intravenosos basado en el aplazamiento de horarios realizado por equipo de enfermería. Métodos: cohorte histórica (retrospectiva) con 110 adultos de unidades críticas. Identificaron medicamentos intravenosos aplazados de modo concomitante, cuyas duplas han analizadas cuanto a la (in)compatibilidad por medio del sistema de screening Trissel's™ 2 Compatibility IV-Micromedex 2.0. Utilizó estadística paramétrica y no paramétrica segundo naturaleza de la variable. Resultados: identificaron 565 duplas de medicamentos. De estas, 44,9% compatibles; y 8,8%, potencialmente incompatibles. Mayoría de las duplas potencialmente incompatibles envolvió substancias con pH alcalino como fenitoína (32%) y bicarbonato de sodio (8%) y ácidos débiles como midazolam (12%) y dobutamina (6%), las cuales podrían resultar en precipitación. Conclusiones: casi mitad de las misturas aplazadas simultáneamente fue compatible, aspecto que, indirectamente, refleja el trabajo orquestado entre el equipo de enfermería y el farmacéutico clínico en las discusiones y decisiones acerca del aplazamiento de horarios.

RESUMO Objetivos: analisar as (in)compatibilidades potenciais de medicamentos intravenosos com base no aprazamento de horários realizado pela equipe de enfermagem. Métodos: coorte histórica (retrospectiva) com 110 adultos de unidades críticas. Identificaram-se medicamentos intravenosos aprazados de modo concomitante, cujas duplas foram analisadas quanto à (in)compatibilidade por meio do sistema de screening Trissel's™ 2 Compatibility IV-Micromedex 2.0. Utilizou-se estatística paramétrica e não paramétrica segundo natureza da variável. Resultados: identificaram-se 565 duplas de medicamentos. Destas, 44,9% foram compatíveis; e 8,8%, potencialmente incompatíveis. A maioria das duplas potencialmente incompatíveis envolveu substâncias com pH alcalino como fenitoína (32%) e bicarbonato de sódio (8%) e ácidos fracos como midazolam (12%) e dobutamina (6%), as quais poderiam resultar em precipitação. Conclusões: quase metade das misturas aprazadas simultaneamente foi compatível, aspecto que, indiretamente, reflete o trabalho orquestrado entre a equipe de enfermagem e o farmacêutico clínico nas discussões e decisões acerca do aprazamento de horários.

A musicoterapia em oncologia: percepções de crianças e adolescentes em cuidados paliativos / Musicoterapia en oncología: percepciones de niños y adolescentes en cuidados paliativos / Music therapy in oncology: perceptions of children and adolescents in palliative care

Resumo Objetivo analisar as percepções de crianças e adolescentes com câncer em cuidados paliativos sobre a musicoterapia. Método pesquisa de campo, com abordagem qualitativa, realizada com sete crianças e adolescentes hospitalizadas. A técnica de desenho-estória foi realizada inicialmente a partir do desenho sobre os sentimentos diante da hospitalização e a estória do desenho. Em seguida, houve a interação musical, desenho sobre o significado da música diante do processo de hospitalização, e a estória do desenho. Para análise, utilizou-se a técnica de análise de conteúdo. Resultados antes da musicoterapia, crianças e adolescentes expressaram sentimentos de tristeza, medo e saudade relacionados ao rompimento do vínculo familiar durante o processo de hospitalização. Após receberem a musicoterapia, elas expressaram as sensações de prazer e bem-estar que essa vivência pode proporcionar, permitindo-lhes a expressão dos sentimentos mais profundos. Conclusão a musicoterapia pode beneficiar a criança e o adolescente com câncer uma vez que permite a expressão de sentimentos, possibilita o resgate de lembranças e proporciona esperança diante da situação vivenciada, além do alívio da dor. Implicações para a prática a musicoterapia contribui no processo paliativista, podendo conferir uma melhor qualidade de vida às crianças e adolescentes com câncer.

Resumen Objetivo analizar las percepciones de niños y adolescentes con cáncer en cuidados paliativos sobre la musicoterapia. Método investigación de campo con enfoque cualitativo, realizada con siete niños y adolescentes. La técnica del dibujo-cuento se llevó a cabo inicialmente basándose en el dibujo de los sentimientos sobre la hospitalización y en el cuento del dibujo. Luego hubo interacción musical, con dibujo sobre el significado de la música durante el proceso de hospitalización y el cuento del dibujo. Para el análisis, se utilizó la técnica de análisis de contenido. Resultados antes de la musicoterapia, los niños y adolescentes expresaron sentimientos de tristeza, miedo y anhelo relacionados con la ruptura del vínculo familiar durante el proceso de hospitalización. Después de recibir musicoterapia, manifestaron las sensaciones de placer y bienestar que esta experiencia les puede brindar, permitiéndoles expresar sus sentimientos más profundos. Conclusión la musicoterapia puede beneficiar a niños y adolescentes con cáncer ya que permite la expresión de sentimientos, posibilita el rescate de recuerdos es fuente de esperanza ante la situación vivida, además de aliviar el dolor. Implicaciones para la práctica la musicoterapia contribuye al proceso paliativo y puede brindar una mejor calidad de vida a los niños y adolescentes con cáncer.

Abstract Objective to analyze the perceptions of children and adolescents with cancer in palliative care about music therapy. Method field research with a qualitative approach, conducted with seven children and adolescents. The drawing-story technique was initially carried out based on drawings on feelings about hospitalization and the drawing story. Then there was the musical interaction, drawing on the meaning of music in the face of the hospitalization process, and the story of the drawing. For analysis, the content analysis technique was used. Results before music therapy, the children and adolescents expressed feelings of sadness, fear and longing related to the breaking of the family bond during the hospitalization process. After receiving music therapy, they expressed feelings of pleasure and well-being that this experience can provide them, allowing them to express their deepest feelings. Conclusion music therapy can benefit children and adolescents with cancer as it allows for the expression of feelings, enables the rescue of memories and provides hope in the face of the situation experienced, in addition to pain relief. Implications for the practice music therapy contributes to the palliative process and can offer better quality of life to children and adolescents with cancer.

Bacterial pneumonia in captive wild boars in southern Brazil: etiological and pathological causes

Respiratory diseases are one of the major health issues described in intensive pig production, causing important economic losses. However, there is little information on the prevalence, etiology and clinical-pathological presentation of these diseases in wild boars. For this reason, this work investigated the presence in captive wild boars of pneumonic lesions and bacterial pathogens commonly detected and associated with respiratory diseases in domestic pigs. A total of 226 captive wild boar lungs from two farms were examined in a slaughterhouse in Southern Brazil. The pneumonic lesions were classified as cranioventral, dorsocaudal, and disseminated, and the quantification of lesions was calculated. From the total of 226 lungs, 121 were collected for laboratory examination. Lungs with macroscopic lesions suggestive of pneumonia were collected for histological, bacteriological and molecular analysis. The molecular analysis was performed to detect the presence of Actinobacillus (A.) pleuropneumoniae, Glaesserella (G.) parasuis, Mycoplasma (M.) hyopneumoniae, Mycoplasma (M.) hyorhinis and Streptococcus (S.) suis serotype 2. The percentages of histological lesions and bacterial agents and their association were calculated. Cranioventral consolidation (75.2%) was the most prevalent macroscopic lung lesion, followed by disseminated (21.5%) and dorsocaudal (3.3%) distribution. Microscopically, chronic lesions were the most prevalent, representing 70.2% of the lungs. Moreover, BALT hyperplasia was present in 86.5% of the lungs, suppurative bronchopneumonia in 65.7%, and alveoli infiltrate in 46.8%. Six bacterial pathogens commonly described as agents of pig pneumonia were identified by bacterial or molecular methods: Pasteurella (P.) multocida, S. suis, M. hyopneumoniae, A. pleuropneumoniae, G. parasuis and M. hyorhinis. Twenty-eight different combinations of pathogens were identified in 84 samples (69.4%). The most common combinations were: M. hyopneumoniae and A. pleuropneumoniae (13.1%), M. hyopneumoniae, G. parasuis and M. hyorhinis (10.7%), and M. hyopneumoniae, A. pleuropneumoniae and G. parasuis (8.3%). Additionally, M. hyopneumoniae was the most frequent pathogen detected in this study, representing 58.7% of the samples. The detection of M. hyopneumoniae and M. hyorhinis by PCR was associated with the presence of BALT hyperplasia (P < 0.05) and there was also an association between the detection of M. hyopneumoniae by PCR and suppurative bronchopneumonia (P < 0.05). In addition, a significant association (P < 0.05) between the detection of M. hyopneumoniae and A. pleuropneumoniae by PCR and the histological classification (acute, subacute or chronic lesions) was observed. The results of this study were similar to those observed in slaughtered domestic pigs, although, the detection of opportunist pathogens was less frequent than that usually described in pig pneumonia. The high prevalence of pneumonia in captive wild boars at slaughter and the similar characteristics of pneumonia in captive wild boars and domestic pigs suggest that the close phylogenetic relationship between pigs and wild boars could influence the susceptibility of both species to the colonization of the same pathogens, indicating that captive wild boars raised in confined conditions could be predisposed to respiratory diseases, similar to domestic pigs.(AU)

Intrinsic Angiogenic Potential and Migration Capacity of Human Mesenchymal Stromal Cells Derived from Menstrual Blood and Bone Marrow.

Several therapies are being developed to increase blood circulation in ischemic tissues. Despite bone marrow-derived mesenchymal stromal cells (bmMSC) are still the most studied, an interesting and less invasive MSC source is the menstrual blood, which has shown great angiogenic capabilities. Therefore, the aim of this study was to evaluate the angiogenic properties of menstrual blood-derived mesenchymal stromal cells (mbMSC) in vitro and in vivo and compared to bmMSC. MSC's intrinsic angiogenic capacity was assessed by sprouting and migration assays. mbMSC presented higher invasion and longer sprouts in 3D culture. Additionally, both MSC-spheroids showed cells expressing CD31. mbMSC and bmMSC were able to migrate after scratch wound in vitro, nonetheless, only mbMSC demonstrated ability to engraft in the chick embryo, migrating to perivascular, perineural, and chondrogenic regions. In order to study the paracrine effects, mbMSC and bmMSC conditioned mediums were capable of stimulating HUVEC's tube-like formation and migration. Both cells expressed VEGF-A and FGF2. Meanwhile, PDGF-B was expressed exclusively in mbMSC. Our results indicated that mbMSC and bmMSC presented a promising angiogenic potential. However, mbMSC seems to have additional advantages since it can be obtained by non-invasive procedure and expresses PDGF-B, an important molecule for vascular formation and remodeling.

Additional Metabolic Effects of Bariatric Surgery in Patients with a Poor Mid-Term Weight Loss Response: A 5-Year Follow-Up Study.

To ascertain the 5-year metabolic effects of bariatric surgery in poor weight loss (WL) responders and establish associated factors. METHODS: Retrospective analysis of a non-randomised prospective cohort of bariatric surgery patients completing a 5-year follow-up. Mid-term poor WL was considered when 5-year excess weight loss was <50%. RESULTS: Forty-three (20.3%) of the 212 included patients were mid-term poor WL responders. They showed an improvement in all metabolic markers at 2 years, except for total cholesterol. This improvement with respect to baseline was maintained at 5 years for plasma glucose, HbA1c, HOMA, HDL and diastolic blood pressure; however, LDL cholesterol, triglycerides and systolic blood pressure were similar to presurgical values. Comorbidity remission rates were comparable to those obtained in the good WL group except for hypercholesterolaemia (45.8% vs. poor WL, p = 0.005). On multivariate analysis, lower baseline HDL cholesterol levels, advanced age and lower preoperative weight loss were independently associated with poor mid-term WL. CONCLUSIONS: Although that 1 in 5 patients presented suboptimal WL 5 years after bariatric surgery, other important metabolic benefits were maintained.

Human Menstrual Blood-Derived Mesenchymal Cells Improve Mouse Embryonic Development.

There is a constant need for improving embryo culture conditions in assisted reproduction. One possibility is to use mesenchymal stem/stromal cells derived from menstrual blood (mbMSCs), with an endometrial origin. In this study, we sought to analyze the expansion of mouse embryos in a direct coculture model with mbMSCs. Our results showed that after five passages, mbMSCs presented a spindle-shaped morphology, with surface markers that were comparable with the normal mesenchymal cell phenotype. mbMSCs could differentiate into adipogenic and osteogenic lineages and secrete angiopoetin-2 and hepatocyte growth factor. The coculture experiments employed 103 two-cell-stage embryos that were randomly divided into two groups: control (n = 50), embryos cultured in GV-Blast medium, and cocultured mbMSCs (n = 53), embryos cocultured with GV-Blast and mbMSCs. Typically, two to three embryos were placed in a well with 200 µL of culture medium and observed until developmental day 5. After 5 days, the cocultured group had more embryos in the blastocyst stage (69.8%) when compared with the control group (30%) (p < 0.001). It was also found that nearly 57% of blastocysts in the cocultured group reached the hatching stage, while only 13% achieved this stage in the control group (p < 0.001). Analyses of cultured mbMSCs and growth media, in the presence or absence of an embryo, were also performed. Immunofluorescence detected similar levels of collagen I and III and fibronectin in both mbMSCs and cocultured mbMSCs, and similar amounts of growth factors, VEGF, PDGF-AA, and PDGF-BB, were also observed in the conditioned medium, regardless of embryo presence. The present study describes, for the first time, an easy, noninvasive, and autologous method that could potentially increase blastocyst growth rates during assisted reproductive procedures (i.e., in vitro fertilization). It is proposed that this mbMSC coculture strategy enriches the embryonic microenvironment and promotes embryo development. This technique may complement or replace existing assisted reproduction methods and is directly relevant to the field of personalized medicine. Impact statement The study demonstrates a novel and potentially personalized assisted reproduction approach. The search for alternative and autologous methods provides assisted reproduction patients with a better chance of a successful pregnancy. In this study, mesenchymal cells derived from menstrual blood resembled the outside uterine surface and could potentially be employed for improving embryo outgrowth. Our protocol enriches the embryonic microenvironment and facilitates high-quality single-embryo transfer.